{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T08:49:58Z","timestamp":1794473398444,"version":"4.9.1"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2018,4,11]],"date-time":"2018-04-11T00:00:00Z","timestamp":1523404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Stenting and flow diversion for aneurysmal sub arachnoid hemorrhage (aSAH) require the use of dual antiplatelet therapy (DAPT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To investigate whether DAPT is associated with hemorrhagic complication following placement of external ventricular drains (EVD) in patients with aSAH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Rates of radiographically identified hemorrhage associated with EVD placement were compared between patients who received DAPT for stenting or flow diversion, and patients who underwent microsurgical clipping or coiling and did not receive DAPT by way of a backward stepwise multivariate analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Four hundred forty-three patients were admitted for aSAH management. Two hundred ninety-eight patients required placement of an EVD. One hundred twenty patients (40%) were treated with stent-assisted coiling or flow diversion and required DAPT, while 178 patients (60%) were treated with coiling without stents or microsurgical clipping and did not receive DAPT. Forty-two (14%) cases of new hemorrhage along the EVD catheter were identified radiographically. Thirty-two of these hemorrhages occurred in patients on DAPT, while 10 occurred in patients without DAPT. After multivariate analysis, DAPT was significantly associated with radiographic hemorrhage [odds ratio: 4.92, 95% confidence interval: 2.45-9.91,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0001]. We did not observe an increased proportion of symptomatic hemorrhage in patients receiving DAPT (10 of 32 [31%]) vs those without (5 of 10 [50%];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .4508).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Patients with aSAH who receive stent-assisted coiling or flow diversion are at higher risk for radiographic hemorrhage associated with EVD placement. The timing between EVD placement and DAPT initiation does not appear to be of clinical significance. Stenting and flow diversion remain viable options for aSAH patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyy127","type":"journal-article","created":{"date-parts":[[2018,3,18]],"date-time":"2018-03-18T08:06:39Z","timestamp":1521360399000},"page":"479-484","source":"Crossref","is-referenced-by-count":48,"title":["External Ventricular Drain and Hemorrhage in Aneurysmal Subarachnoid Hemorrhage Patients on Dual Antiplatelet Therapy: A Retrospective Cohort Study"],"prefix":"10.1227","volume":"84","author":[{"given":"Joseph S","family":"Hudson","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin S","family":"Prout","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunori","family":"Nagahama","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daichi","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waldo R","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Zanaty","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nohra","family":"Chalouhi","sequence":"additional","affiliation":[{"name":"Dep-artment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Dep-artment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudeepta","family":"Dandapat","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Allan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Ortega-Gutierrez","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"},{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"},{"name":"Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar A","family":"Samaniego","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"},{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,2]]},"reference":[{"issue":"6","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1161\/STR.0b013e3182587839","article-title":"Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"43","author":"Connolly","year":"2012","journal-title":"Stroke"},{"issue":"6","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1161\/01.STR.20.6.718","article-title":"Has there been a decline in subarachnoid hemorrhage mortality?","volume":"20","author":"Ingall","year":"1989","journal-title":"Stroke"},{"issue":"5","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1212\/WNL.50.5.1413","article-title":"The burden, trends, and demographics of mortality from subarachnoid 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